Aspirin Dosing for the Prevention and Treatment of Ischemic Stroke: An Indication-Specific Review of the Literature

Abstract

OBJECTIVE: To evaluate the efficacy of aspirin for the treatment and prevention of ischemic stroke and identify the minimum dose proven to be effective for each indication. DATA SOURCES: PubMed and MEDLINE searches (up to January 2010) were performed to identify primary literature, using search terms including aspirin, stroke prevention, acute ischemic stroke, acetylsalicylic acid, atrial fibrillation, myocardial infarction, and carotid endarterectomy. Additionally, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: Articles published in English were evaluated and relevant primary literature evaluating the efficacy of aspirin in the prevention of stroke was included in this review. DATA SYNTHESIS: Antiplatelet therapy is the benchmark for the prevention of ischemic stroke. Aspirin has been proven to prevent ischemic stroke in a variety of settings. Despite the frequency at which aspirin continues to be prescribed in patients at risk of ischemic stroke, there remains confusion in clinical practice as to what minimum dose is required in various at-risk patients. A thorough review of the primary literature suggests that low-dose (50-81 mg daily) aspirin is insufficient for some indications. Acute ischemic stroke treatment requires 160-325 mg, while atrial fibrillation and carotid arterial disease require daily doses of 325 and 81-325 mg, respectively. CONCLUSIONS: Available evidence suggests that aspirin dosing must be individualized according to indication. Recommendations provided by national guidelines at times recommend lower doses of aspirin than have been proven effective. Higher doses are indicated for stroke prevention in atrial fibrillation (325 mg) and acute ischemic stroke patients (160-325 mg). Aspirin has not yet been proven effective for primary prevention of strokes in men, and a minimum dose for these patients cannot be determined from the available data.

Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?

“…In platelets aspirin inhibits the formation of thromboxane A 2 which is a potent platelet activator [37, 38]. Since aspirin also affects the cyclooxygenase in gastric mucosa which can lead to serious bleeding, it is used as an inhibitor of platelet function for the prevention in patients with risk for atherothrombosis in rather low dosage, that is, ≤325 mg/day, and in many patients at dosage lower than 160 mg/day [35, 36, 39–42]. …”

Gastroprotection in NSAID and low-dose aspirin users: A cross-sectional study in primary care

“…1 Low-dose aspirin (LDA) (75---325 mg/day) is also highly prescribed because it reduces the risk of vascular events and death in patients with coronary and cerebrovascular disease. 2 Gastrointestinal (GI) complications are the most frequent side effects associated with NSAID and LDA use, which may potentially lead to patient death. 3 GI complications range from the development of dyspepsia and symptoms of drug intolerance to clinically significant gastroduodenal ulcer complications such as bleeding, obstruction and perforations.…”

Interações Medicamentosas Potenciais Na Farmacoterapia De Idosos Atendidos Em Farmácia Básica Do Sul Do Brasil

“…Em estudo realizado na Unidade Básica de Saúde de Ribeirão Preto/SP com 40 idosos, os fármacos Hidroclorotiazida e o Ácido Acetilsalicílico foram os mais prevalentes e este último como o responsável pela maioria das interações 30 , corroborando com o encontrado nesse estudo. O ácido acetilsalicílico, tem sido utilizado há muito tempo em idosos, na prevenção de eventos trombolíticos 32 .…”